In New York, access to medical marijuana still a challenge

Horticulturalist Chuck Schmitt talks about the marijuana plants in the greenhouse at the Vireo medical marijuana facility in the Tryon Technology Park on Wednesday, Sept. 21, 2016 in Johnstown, N.Y. (Lori Van Buren / Times Union) less

Horticulturalist Chuck Schmitt talks about the marijuana plants in the greenhouse at the Vireo medical marijuana facility in the Tryon Technology Park on Wednesday, Sept. 21, 2016 in Johnstown, N.Y. (Lori Van ... more

Horticulturalist Chuck Schmitt talks about the marijuana plants in the greenhouse at the Vireo medical marijuana facility in the Tryon Technology Park on Wednesday, Sept. 21, 2016 in Johnstown, N.Y. (Lori Van Buren / Times Union) less

Horticulturalist Chuck Schmitt talks about the marijuana plants in the greenhouse at the Vireo medical marijuana facility in the Tryon Technology Park on Wednesday, Sept. 21, 2016 in Johnstown, N.Y. (Lori Van ... more

ALBANY — It's been three years since the first New Yorkers began taking medical marijuana through an official state program.

Ever wonder how that's going?

By many measures, observers note, it's going well. Regulatory changes increased the type and number of practitioners who could register for the program, five new organizations were allowed to open manufacturing and dispensing facilities, and the list of qualifying conditions expanded to include post traumatic stress disorder, chronic pain and opioid use disorder.

But by other measures, New York falls short: It prohibits the cheapest and most commonly used form of marijuana — the dried flowers from the plant. And with other barriers to access, like far-flung dispensaries and a lack of insurance coverage, marijuana, which is cannabis, remains a medicine that only a small number of New Yorkers can afford.

"Right now we basically have a two-tier system where if a patient is well-resourced they can access this medication and if they're not, they can't," said Melissa Moore, New York deputy director for the Drug Policy Alliance. "That's pretty untenable when we talk about patient care."

The state Health Department issued its own status report on the program Nov. 14, outlining progress so far as well as 11 recommendations it believes would help expand access to patients who may be going without or self-medicating with illegally obtained and unregulated products.

By the numbers

As of June 30, 98,101 patients were certified to participate in New York's medical marijuana program — a more-than-threefold increase from just one year earlier. Just 61,198 of them were active, though, with the others holding registrations that had expired or were canceled.

More than half, 53 percent, of participating patients qualified as a result of severe or chronic pain. And most were older New Yorkers, with 23 percent in the 51- to 60-year-old age group and 19 percent in the 61- to 70-year-old group.

Perhaps more indicative of the program's effectiveness are the data on returning patients, or patients who visit a dispensary once and return for more products later on.

State health officials report that only 66.5 percent of all patients who visit a dispensary ever return, either due to cost, distance to a dispensary, how well the product worked or, in the case of terminally ill patients, death.

This figure is up from 61.1 percent in January 2017, though — a sign of some improvement, perhaps due to the emergence of home delivery service in some areas of the state.

In order to become certified for the program, a patient must first visit a practitioner who has taken an online course and registered with the state.

As of June 30, 1,718 doctors, physician assistants and nurse practitioners had registered with the state. Though that number is up from just 1,098 one year earlier, a number of local practitioners report that stigma and ignorance around the medical uses of marijuana prevents many from registering.

Recommendations

With the burden of cost now a well-documented concern, state health officials are recommending New York pursue a pilot study with one or more third-party payers to assess the cost-benefits of health insurance coverage for medical marijuana.

Health insurance companies have been hesitant to cover medical cannabis until federal laws outlawing marijuana are reformed. But there is no reason why state law should prevent private insurance carriers from covering medical marijuana, according to Americans for Safe Access, a Washington, D.C.-based group that promotes safe and legal access to medical cannabis.

In fact, it argues, an ideal law would require insurance carriers and state health programs to treat medical cannabis like any other legal drug. A bill introduced last month by Assemblyman Richard Gottfried, D-Manhattan, would require public health plans in New York, including Medicaid, to do this.

"Until the cost of medication is addressed there will still be big challenges for patients," said Moore, whose group advocates for lifting the ban on whole flower products, which are cheaper than edibles, tinctures and other forms of marijuana.

Other recommendations in the report include allowing practitioners, based on clinical evaluation and their discretion, to certify patients who previously did not qualify for medical marijuana; permitting all practitioners who can prescribe controlled substances to people to become registered providers; implementing regulatory amendments to promote research studies of approved medical marijuana products, and allowing registered organizations to use third-party contractors for security.

"The Department of Health is committed to growing New York's medical marijuana program responsibly," department spokesman Jonah Bruno said. "The program has helped thousands of New Yorkers suffering from serious health conditions."